血清PCT、CRP及中性粒细胞百分比辅助诊断血流感染的临床价值

Clinical values of serum PCT, CRP and neutrophil percentage in diagnosis of bloodstream infection

目的 通过受试者工作特征(ROC)曲线评价血清降钙素原(PCT)、C-反应蛋白(CRP)、白细胞计数(WBC)、血小板计数(PLT)、中性粒细胞百分比(NEUT%)、淋巴细胞百分比(LYMPH%)、血沉(ESR)七种炎症指标对病原菌引起的血流感染(BSI)的诊断价值。方法 以2013年3月-2019年7月连云港市第二人民医院进行血细胞培养分析检查的1 580例住院患者作为研究对象,根据血培养结果进行分组,其中革兰阳性菌组186例、革兰阴性菌组520例、阴性对照组868例,分析三组患者炎症指标对BSI的诊断价值;对上述三组患者炎症指标之间的水平差异进行比较。结果 三组PCT、NEUT%、LYMPH%、CRP、WBC、PLT水平差异具有统计学意义(P<0.05);PCT、NEUT%、LYMPH%、PLT、CRP、WBC对革兰阴性菌BSI诊断价值差异有统计学意义(P<0.05);NEUT%、LYMPH%、PCT、WBC对革兰阳性菌BSI诊断价值差异有统计学意义(P<0.05)。结论 不同炎症指标对BSI的辅助诊断价值不同,相同炎症指标对不同BSI类型的辅助诊断价值各异,可以为临床上对不同病原菌BSI进行辅助诊断时选择合适的炎症因子进行实验室检查提供依据。

OBJECTIVE To evaluate seven inflammatory indicators of serum procalcitonin(PCT), C-reactive protein(CRP), white blood cell count(WBC), platelet count(PLT), neutrophil percentage(NEUT%), lymphocyte percentage(LYMPH%) and erythrocytese dimentationrate(ESR) in bloodstream infections(BSI) caused by pathogenic bacteria by subject work characteristics(ROC) curves. METHODS From Mar, 2013 to Jul, 2019 1580 inpatients who underwent blood cell culture analysis and examination in the Second People’s Hospital of Lianyungang were enrolled as the study subjects. They were divided into the gram-positive cocci group with 186 cases, gram-negative bacilli group with 520 cases and the negative control group with 868 cases according to the results of blood culture. The diagnostic value of inflammatory indicators among the three groups were analyzed and compared. RESULTS The differences in PCT, NEUT%, LYMPH%, CRP, WBC and PLT levels among the three groups were significant(P<0.05). The diagnostic value of PCT, NEUT%, LYMPH%, PLT, CRP and WBC for Gram-negative bacteria BSI was significant(P<0.05). The diagnostic value of NEUT%, LYMPH%, PCT and WBC for Gram-positive bacteria BSI was significant(P<0.05). CONCLUSION Different inflammatory indicators have different values for the adjunctive diagnosis of BSI, and the same inflammatory indicators have different adjunctive diagnostic values for different types of BSI. The findings of this study can provide a basis for the clinical selection of appropriate inflammatory factors for laboratory tests in the adjunctive diagnosis of BSI with different pathogens.